Would you pay me to be healthy?

By Todd A. Ward, PhD, BCBA-D

Founding Editor, bSci21.org

Aaron Carroll of the New York Times recently wrote an article describing a growing body of research supporting the idea of paying people to be healthy.

He notes, for example, a study published in the New England Journal of Medicine that payed people to quit smoking. The study found that paying people $100 at predetermined intervals, as well as bonuses for each person in their groups that quit smoking, worked the best.

He also cites other examples. For example, a study in the American Journal of Preventative Medicine showed that monetary incentives can effectively increase a variety of preventative health behaviors. Additional studies have shown that “Voucher Based Reinforcement Therapy” can effectively treat substance-abuse disorders, lottery systems can combat obesity, and that financial reinforcers can increase medication compliance.

However, Aaron points out that the public is hesitant to endorse paying people to “do what they should already be doing.” For example, he cites resistance from a program to provide birth control to drug users. It’s a simple matter of countercontrol — if enough people in a society find your policy aversive, they will act to remove the source of aversive control (i.e., your policy).

This is an important point often missed by behavioral scientists — just because research might demonstrate the effectiveness of a particular type of intervention, that doesn’t mean the intervention should be widely disseminated. The ends don’t always justify the means. You see this in politics all the time. There seems to be a perennial debate between Republicans and Democrats over the right way to do things. In actuality, they are both interested in many of the same ends, like education and jobs. However, they both typically value different means to achieve said ends: Republicans generally favor the private sector, whereas Democrats typically favor government intervention.

A scientific perspective says nothing on which approach “should” be implemented. All science can say is how particular means can achieve certain ends. If one is found to be better at achieving certain ends, that doesn’t necessarily mean it should be widely adopted. Adoption depends on your values.

What are your thoughts on this? Is effectiveness sufficient for adoption? Let us know in the comments below and don’t forget to subscribe to bSci21 via email to receive the latest articles, and free monthly issues, directly to your inbox!